Question 1
The study
discussed the importance of establishing healthy eating habits early on. As
future RDs what ways can we educate the public on this matter? What advice can we give families with picky
eaters?
posted by Moriah Gramm @ 9:43 AM
13 comments
13 Comments:
One of my favorite handouts I provide to my WIC clients during appointments briefly covers tips for children who are picky eaters. It explains that parents are responsible for providing healthy foods at the appropriate times, but the child is responsible for how much they choose to eat. A lot of parents struggle with this concept and end up making a separate meal for their picky eat, which ultimately doesn’t do anyone any good. This enables the child to continue patterns and not expand their horizons when it comes to foods. It also creates more work for parents. RDs can provide parents the tools and information they need to help their child incorporate multiple foods and try new things, benefiting the parent and child. It is important to take the time to explain why fruits and vegetables are important to the child’s health and development, but it is also important to take the time to listen to the parent’s concerns. As dietitians we can provide them with the tools parents need, but if the picky eating does not subside and is causing nutritional deficiencies other professional intervention may be needed.
I think it is important to educate on the importance of nutrition for parents as well as their child/children. While it is difficult to change picky eating habits, that may be a result of a parent's diet. Teaching parents about long-term health benefits of consuming fruits, vegetables, and whole grains can influence their diet as well as their children.
When providing tips and strategies for parents, something to consider is having children try new fruits/vegetables as they are, or as the main component (green bean side dish, salad, etc) rather than always "hiding" their vegetables in foods (purreed veggies in pasta sauce). Having the child actually taste the vegetable and see what it looks like can be good exposure for them to make an opinion about it. If a child doesn't know they were always consuming vegetables and they grew up to make food choices for themselves, vegetable consumption may not be as high compared to being exposed to the vegetable in it's full form. Also, using color as a way to encourage children to eat their vegetables may help them try new foods. Colors appeal to children and although vegetables may seem foreign to them, trying new colored vegetables may make it more exciting for children. These are simple strategies for parent's to use, but can be very effective for children, especially young children that don't have a strong negative viewpoint of vegetables yet.
Early education is key, and I feel that this should start before the child is born. We recommend prenatal vitamins and the cessation of smoking and drinking in order to promote healthy fetus development. I think that nutrition education is also important for the parents durning this time as well. If they can develop healthier eating habits before the child is born, they could be more likely to continue these habits as the child grows. Nutrition education should focus on why it's important to eat fruits and vegetables, not only for adult health but also the impact it has for child growth and development. Regardless, I think that exposing children to fruits and vegetables continually so that they become familiar with the produce. Ideally, vegetables should be introduced before fruits since babies are more inclined to prefer the sweeter fruits over the more bitter vegetables.
I agree with Tessa in which we should discourage parents from creating a whole separate meal for picky eaters. Parents who act as positive models for healthy eating behaviors can help to limit pickiness, but ultimately many children refuse to try something because it is new to them. Continual exposure will help to make the children more open to the idea of the new item. I also feel that we should discourage the "clean plate club" mentality, in which children are required to finish all of their food. This can be a fine line between the child's level of satiety and not eating enough to meet nutritional/energy intake.
I like the idea of starting nutrition education with parents before the child is even born. If parents understand the importance of a healthy diet for growth and development and know how to encourage fruit and vegetable consumption, their children may be more likely to eat a variety of foods. Teaching parents how to encourage healthy eating in kids would be key. This would also involve modeling, which the study also claimed was influential on diets of young children. If a child sees his/her parents eating fruits and vegetables at every meal, he/she may have more acceptance of different foods and be a less picky eater.
I think that part of discouraging picky eating also involves allowing the children to make their own food decisions when possible. If children are always force-fed veggies, it will not be surprising when they dislike them. This goes back to what Tessa mentioned about the WIC handout which highlights the importance of providing healthy choices and allowing children to be responsible for food decisions.
I agree with what Nikki said about openly incorporating fruits and veggies into children's diets. Hiding fruits and vegetables in more kid friendly dishes may increase their nutrition, but it will not set them up for a lifestyle abundant in fruits and vegetables. Making sampling new produce fun and involving parents and siblings in trying new vegetables may make healthy eating fun and part of a normal day.
I agree with Holly's point about how we educate parents about omitting alcohol and smoking for healthy fetus development, and that nutrition education should be talked about for the health of the mother as well as the child during pregnancy as well. When educating the mother, touching on the importance for child development can motivate the mother to change her eating habits. While it is crucial for her own health, motivation for a healthier child may bring about more change.
During my rotation at UPH Methodist, one of my projects was to review the Ellyn Satter Method in how to counsel a parent of a picky eater suing the institute’s method. These were my findings:
The Ellyn Satter Method (ESM) encourages healthy food relationships for children by promoting the responsibility of feeding to parents and child care providers. According to ESM, children are born with the ability to regulate/determine how much they need to eat for their own individual growth and development. As children grow from infancy to childhood and beyond, their innate ability to eat appropriately for themselves matures too, ultimately allowing them to become eating competent. It becomes the parents’ responsibility to provide healthy food options from which to eat; adults know more about food. Thus, ESM breaks the responsibility of feeding children into two components, how much (child) and what (parent).
The Ellyn Satter Method recognizes that children will not starve themselves, will eat according to their body’s needs and they will grow up into bodies that are right for them. Forcing toddlers to eat when they do not want to or think they need to will lead to frustration with both parties and will likely create unhealthy food behaviors that will be difficult or impossible to alter as the child grows and develops. Overall, raising a healthy eater takes years and developing healthy attitudes and behaviors about food are more important than what a child eats at any given meal or day. By developing healthy attitudes and behaviors your child will eat well and get the nutrition he or she needs.
Additionally, as the articles mentioned the Ellyn Satter Method also found that if a toddler sees there parent/caregiver eat and enjoy a variety of foods then over time the child will model these behaviors, eventually learning to eat and enjoy the foods their parents eat.
Following this simple advice could be one ways as future RD we could educate the public on this matter and help establish healthy eating habits early on.
A topic I did research on in undergrad and am very passionate about is the importance of family meal time. Literature has found family mealtime to be correlated with healthy habits in young children. These healthy habits have also been shown to continue into adulthood. Eating meals as a family is a simple, easy way to reach small children and build upon wholesome eating from a young age. However, we as dietitians should educate patients that simply eating together at the table is not enough to assist with adequate nutritional status. Meals times should be positive with pleasant conversation and lack of distraction from media devices. Family meal times that are contain fighting, negativity, etc. can have adverse effects on building healthy habits in children. Additionally, children can get involved with meal time in other ways as well by helping cook, set, or clear off the table.
It is clear that eating habits learned early in life carry through to later life stages and can have effects on lifelong health. The study itself focused on the effects of eating habits at 3, 9, and 18 months on eating habits at 3.5 years. While picky eating habits in younger years can have an effect on eating habits later on, picky eating occurs as a stage in many children. Picky eating is common in young children, but is not necessarily a long lasting problem in all children. Children often will outgrow their picky eating habits and expand their tastes eventually. Parent modeling of healthy eating and appropriate coping strategies for picky children can help set a solid foundation for long-term healthy eating habits. As others have mentioned, early education for parents is key to supporting positive and healthy eating habits for children. A class or support group for parents could be an effective means of education. Managing children with picky eating habits, especially when these habits cause inadequate nutrient intake, begins with understanding that children will not starve themselves if they do not like the food being served. Parents should know that catering to specific picky requests continuously can increase the stress on the meal preparer and worsen the picky problem as the child learns that they can get the food they want through complaining. Other advice could include making meal time relaxed and distraction-free, allowing children to help plan and cook meals, and encouraging trying at least two bites of each food served at every meal.
As Tessa said, we as RDs are responsible for providing parents with the tools needed to navigate picky eating and child nutrition. I agree with Nikki’s comment about allowing and encouraging children to try foods in their natural form. While nutritional status can be improved by “sneaking” veggies into things, it is important to also offer these items by themselves so children can learn about the true texture, taste, and appearance of healthy foods like fruits and vegetables. Further, it can be very beneficial to show children what certain foods look like before and after they are prepared, as well as what they taste like raw versus cooked. Noel’s emphasis on the importance of family meal times is also a component of healthy eating habits for children. A positive meal time with family sets the stage for a positive eating experience and relationship with food. A stressful or chaotic meal time will likely create negative feelings for the children and launch them into their picky behaviors as a coping mechanism.
As many of you have mentioned education is key. Tessa, as you commented, having a readymade handout on picking eating is a valuable education resource. I agree with Nikki’s and Holly’s comments on providing education to parents and caregivers about eating healthy for both themselves and their children and why it is important it benefits everyone. This education can go a long way towards creating healthy food habits and relationships with food that will usually limit picking eating and improve parental diets too. Education can also help improve meal time stress; making meals and food enjoyable for all involved. Noel, I think you made a great point about having children be more involved with meals (prep work, setting the table, etc.) can also be an effective way to decrease picky eating habits and improve meal time enjoyment.
As the article emphasizes, picky eaters may be assisted through repetitious offering of any given food item. The establishment of expected behaviors such as healthy eating may be best ingrained, or whole-grained, through the early example of family members. Education to family members is crucial if there is to be any success in changing the diet of a pre-school aged child. In common knowledge, children hold little power in the household relying on parents and caregivers to enforce positive choices and environments, as emphasized by the Davison and Birch model of the article. To this turn, the easy availability to nutrition related resources at a community level may support families in forming constructive nutrition habits. The introduction and sustaining of farmer's market, community garden, 4-H, extension, and other cooking outreach may provide some of the continued education required. As overheard recently, a major draw of WIC clinics is the availability of coupons, credits and discounts for child supplies to new parents. The continue incentivizing of healthier choices through discount and qualification for bonus programs may help reach some individuals not inspired by standard risk factor education.
Kandice the advice you encountered and distributed at your rotation is valuable. In the place of panic, it is simpler to respect traditional sense that most children will eat. Far from restricting any budding individuality the insistence that what is served for dinner is all that will be offered teaches balance, control in food consumption. Further giving the power to eat back to the child, alleviates stress from the parent and enhances the positive atmosphere of the meal.
I appreciate Kandice bringing in her knowledge of the Ellyn Satter Method as it is one I have never heard of before. I find the point interesting how "children will not starve themselves, will eat according to their body’s needs and they will grow up into bodies that are right for them." Kirsten also brings up a good point that most children will go through a phase of picky eating; it is unavoidable. I think this fits the Elly Satter Method well in that maybe picky eating should be approach less harshly and an understanding of the broader picture should be considered.
As the research shows, early childhood is a critical time for healthy eating habits to develop. Educating the entire public of this matter would help to make this information universal knowledge to everyone. Depending on the resources available, a commercial on TV or the radio about this would reach a broad audience. In order to reach the target population, having education for parents BEFORE their children are born would likely be an effective.
For families with picky eating, they should be continuing to introduce new foods to them regularly. And, if they are school-aged kids, I would emphasize the importance of family meals where everyone sits down together and eats the same meal. Offering a couple choices for a vegetable or fruit is okay too because it makes the child feel like they are still making their own decision. The thing is, they need to eat what they choose rather than not eating dinner and then asking for more of the food they like right after dinner.
In response to Kandice, I like your description of the methods that dietitians at Methodist use to counsel a parent of a picky eater. The child choosing how much food and the parent choosing which foods they will eat sounds like a great approach. I would say that this should be an initial approach to tackling picky eating, but then after a while it seems that children should be able to have some choice in the matter. Even if it’s giving them two options instead of one, this will help them learn how to make these decisions in the future.
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